“”In the second of two posts guest blogger Oliver Sabot from the Clinton Health Access Initiative reflects on the challenge and opportunity of scaling-up access to effective treatment for diarrhea, the second largest cause of child mortality globally. The posts …”

To improve treatment of acute diarrhea, the Bill & Melinda Gates Foundation recently gave a two-year, $1.8 million grant to the Yale School of Medicine to design clinical trials to test the effectiveness of a major modification of oral rehydration solution ( ORS ) in the treatment of acute diarrhea in children in developing countries.

After working together on various aspects of this project for more than 15 years, a team of scientists — Dr. Henry J. Binder, professor of medicine and of cellular and molecular physiology at Yale, and his two collaborators Dr. B.S. Ramakrishna, professor of gastroenterology at Christian Medical College, Vellore, India, and Professor Graeme P. Young, head of the Flinders Centre for Cancer Prevention and Control, Flinders University, Adelaide, Australia — have proposed a modified ORS, based on the addition of a starch that reduces fluid loss.

“The development of ORS to treat diarrhea more than three decades ago has been considered one of the most important milestones in therapeutics during the last century,” says Binder. But although oral rehydration therapy has been responsible for a substantial reduction in infant mortality in the developing world, Binder says, “It is not used as much as it should be for many reasons, including the failure of mothers and caregivers to appreciate its effectiveness. Although ORS corrects dehydration, it does not reduce diarrhea.”

Since diarrhea can be caused by bacterial, viral and parasitic infections, an improvement in current therapies will have far-reaching impact, say the scientists. The primary objectives of this two-year planning grant are to establish a network of sites to collaborate in a series of clinical trials in developing countries, and to identify the most effective starch to be used in these trials.